WA 0859 3970 0884 Biaya Jasa Kontraktor Plafon WPC Duma Terpercaya Nogosari | Gift of Life Donor Program

Name

This field is for validation purposes and should be left unchanged.

Name*

First Last

Email*

DMV Location*

Date of Visit*

Organ Donation Brochures: Are they visible and accessible to the customers?*

Yes
No

Spanish Organ Donation Brochures: Are there any Spanish brochures available?*

Yes
No

Posters: Are the posters hanging on the walls visible for people waiting in line to see?*

Yes
No

Spanish Posters: Are there any Spanish posters?*

Yes
No

Are there any other Organ Donation Materials (such as ads for the Donate Life license plate, etc).*

Yes
No

Please list, if applicable.

In DE DMVs and select PA DMVs: Is the TV on and showing Donate Life advertising/messaging?*

Yes
No
N/A

In DE DMVs and select PA DMVs: Did you speak with a DMV employee?*

Yes
No
N/A

If so, what is the name of the DMV employee you spoke with?*

Please list any suggestions for how the organ donation materials can be better displayed or suggestions for additional promotional materials within the DMV?

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Department of Motor Vehicle’s Site Survey

Adopt-A-DMV Form

Department of Motor Vehicle’s Site Survey

Adopt-A-DMV Form

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